Blood Flow Restriction

Training
A guide to implementation of BFR training.

made with
Table of Contents

1. About The Author

2. The Science of Blood Flow Restriction Training

3. The Application of Blood Flow Restriction for Performance Gains

4. The Best Blood Flow Restriction Bands and Devices

About The Author
Board Certified Specialist in Sports Physical Therapy

Dr Zachary K. Long

Zach Long is a board certified specialist in sports physical therapy and

Strength & Conditioning coach.

He attended the University of North Carolina at Chapel Hill, where he

majored in exercise and sport science, and East Carolina University,
where he earned his doctorate in physical therapy.

Long's work focuses on rehab and performance of athletes of all skill

levels. He currently teaches BFR rehab as part of the clinical education
team at OwensRecoveryScience.com.
The Science of Blood Flow
Restriction Training

Blood flow restriction training is one of the newest training tools to hit
both the rehab and performance worlds and with good reason, there is
a lot of research coming out supporting the use of this modality for
strength and hypertrophy gains.

The majority of research focuses on looking at strength and

hypertrophy gains during BFR training. Research on traditional loading
requirements for hypertrophy during weightlifting suggests loads as
heavier than 65% of an individual’s one rep max (1rm) must be used to
create hypertrophy gains. So a 200lb bench presser must bench at
loads greater than 130lbs to create a hypertrophy response.

Research on blood flow restriction training shows that loads as low

as 20-30% of 1rm can create the same hypertrophy stimulus!
Comparison of traditional high intensity resistance exercise (HIT) to BFR
training and low intensity training (LI)

Other research looking at strength gains has show significant

increases in strength during BFR training. Compared to typical high
intensity training, these strength gains are less, but can still have
significant impact on an athlete’s return from injury or their sports
performance.

Comparison of traditional high intensity resistance exercise (HIT) to BFR

training and low intensity training (LI)

So how does BFR create this hypertrophy and strength stimulus? Let’s
first look at a simplified formula for muscle growth:

Amount of Muscle Growth =

Muscle Protein Synthesis – Muscle Protein Breakdown

Simply put if you add more protein to your muscles than you
breakdown, you will build muscle. If you breakdown more than you
synthesis, you lose muscle.

MUSCLE PROTEIN BREAKDOWN

In traditional resistance exercise, loading the muscle stretches the
sarcomeres leading to cytoskeletal matrix damage. An inflammatory
cascade follows to build muscle (there is currently multiple theories on
this out there but I’m not going into any details).

During BFR, measures of muscle damage such as creatine kinase, lipid

peroxides, torque output of muscles, and delayed onset muscle
soreness (DOMS) are minimally elevated. Meaning in our muscle growth
formula, we don’t have muscle protein breakdown!

MUSCLE PROTEIN SYNTHESIS

During blood flow restriction training, limited oxygen to the muscle
means that the slow-twitch, Type I muscle fibers aren’t very active as
they require oxygen as fuel. Instead, the bigger, faster Type II muscle
fibers are recruited. To recruit Type II muscle fibers during traditional
resistance exercises we usually need to perform exercises at very high
intensity. But the oxygen limitations flip that upside down!

Why does that matter? Lactate acid is very important to growth

hormone release. In fact, growth hormone secretion levels are 170%
higher after BFR than traditional resistance exercises!

Now contrary to popular belief, growth hormone is not involved in

protein synthesis or muscle hypertrophy. Instead, it serves a protective
role for tendons and muscle collagen structures as it increases collagen
synthesis. This has important rehab from injury implications as well as
making BFR a great tool for recovery in atheltes.

When it comes to the genes and hormones directly related to muscle

hypertrophy, BFR has been shown to have significant positive benefits
on IGF-1, MTORC1, and myostatin.

Meaning that blood flow restriction training creates a large increase in

muscle protein synthesis.

Back to our muscle growth formula….

A large increase in protein synthesis with little muscle damage
means we are putting the body in a very good place for building
muscle!

As a great case example, elite Olympic weightlifter Jared Fleming tore

his ACL at the world championships and did his rehab with me utilizing
blood flow restriction training. While lots of research suggests that 65%
of patients demonstrate >20% quad weakness compared to
contralateral 1 years after ACL reconstruction (Sachs 1989), Jared's
surgical leg was 1 inch larger than his healthy leg three months after
surgery!

https://www.instagram.com/p/BDEIslxBE20/?taken-by=thebarbellphysio

Here is a quick overview of all of the above:

Blood Flow Restriction from LiftersClinic.com

For clinicians wanting to know more about blood flow restriction

training, check out courses offered at OwensRecoveryScience.com.
The Application of Blood Flow
Restriction for Performance Gains

Blood flow restriction training has emerged as a game changing rehab

and performance tools. While traditional resistance exercise strength &
hypertrophy must be done with heavy loads, blood flow restriction is the
opposite. With blood flow restriction strength and hypertrophy gains
have been shown in research at loads as low as 20% of an individual’s
one rep maximum.

For a quick recap of the research, blood flow restriction training doesn’t
break down the muscle like traditional resistance exercise because the
loads are so light. Instead, BFR creates huge amounts of protein
synthesis due to the hormonal responses the body has to BFR training.

While the majority of research has focused on rehab implications of

blood flow restriction training, there are also lots of potential
performance enhancement results for athletes wanting to perform at
their best. blood flow restriction strength

Cuff Placement
There are only two places that a blood flow restriction device should be
placed: the upper arm and at the upper thigh. Frequently,
recommendations of cuff placement at the upper calf or forearms are
made. With very superficial nerves in these areas, the amount of
compression from a blood flow restriction cuff can cause serious
damage resulting in medical conditions such as foot drop. So I’ll say it
again, there are only two places that a blood flow restriction device
should be placed: the upper arm and at the upper thigh.
Cuff Pressure

If using a blood flow restriction training device that allows you to

precisely measure the amount of blood flow occlusion (Occlusion Cuff
or Delphi unit), we suggest using 50% occlusion for the upper body and
80% for the lower body. This means that all venous blood flow and
restricted and only a portion of arterial blood flow comes into the leg.

Due to FDA regulations, medical professionals should only use the

Delphi unit as it is the only FDA approved device for BFR.

For those using compression bands, wraps, or other non-objective

devices, I suggest using a pressure of 4-5 out of 10 for the upper body
and 6-7 / 10 for the lower body.

Exercise Selection

Almost any exercise used to build strength and hypertrophy can be

used with blood flow restriction. From bodyweight to weighted, from
open kinetic chain to closed. Power, speed, and jumping exercises
should not be used.

Amazingly, several studies have looked at the effects of blood flow

restriction training while cycling and walking. With both of these, gains
in muscle mass, strength, and VO2 max have been seen. These changes
have been as crazy a college basketball players having an 11.6%
increase in VO2 max after walking twice a day with BFR for two weeks.
No there was not a typo there….2 weeks….11.6% increase! blood flow
restriction strength

https://www.instagram.com/p/BDD64XCBE7S/?taken-by=...

Sets and Reps

The 30/15/15/15 protocol is what appears the most in the literature and
from a clinical and practical application. Here’s the breakdown:

30 reps with a 2 second concentric and 2-second eccentric contraction

30 seconds rest

15 reps

30 seconds rest

15 reps

30 seconds rest

15 reps

30 seconds rest

blood flow restriction strength

If the total of 75 reps cannot be completed, repeat the weight next

workout (unless less than 50 reps were completed then lower the
weight). If completing the 75 reps isn’t SIGNIFICANTLY hard, increase
the resistance next time.

Other than that, general rules of weight and / or exercise progression

are in play.

BFR training should be performed after other weight lifting exercises.

Here are some more specific examples of how we could use Blood Flow
Restriction training for specific athletes.

CrossFit Athlete

CrossFit requires the practice of a wide variety of exercises and skills.

To be competitive at the highest level, most athletes have had to take to
performing multiple workouts per day. If an athlete knows that a
particular body part is weak, it is very difficult to add more training
volume to his or her weekly schedule.

For example, an athlete with weak triceps or a weak bench press could
add one workout per week of BFR bench press. The light loading
doesn’t create muscle damage, meaning the athlete’s CrossFit
workouts will not be hindered by the added training session. blood flow
restriction strength

Olympic Weightlifters and Power Lifters

The same applies for Olympic lifters and I’ve been implementing BFR
with my elite lifters for some time now. These elite lifters are already
working out 6-10 times per week. Adding heavy resistance training
volume isn’t an option. BFR is a great option to improve strength &
hypertrophy without interfering with their already high training load.

A great program for adding lower body size can see below in Olympic
lifter Lindsey Stroker who is performing BFR split squats to improve
lower body strength.

https://www.instagram.com/p/BJN4cRhhPoa/?taken-by=...

Bodybuilders

Bodybuilders obviously can about muscle hypertrophy above all else

and BFR is an amazing tool for them to add to their arsenal.

Two ways I see this implemented:

First, as a metabolic finisher after a workout of heavy resistance

exercises. They might perform close grip bench press, tricep
pushdowns, and finish off with BFR dumbbell tricep extensions.

Secondly, blood flow restriction can be a great way to add a second

daily workout into their training schedule without impeding recovery.

In Season Athlete

For athletes like basketball or baseball players with multiple games per
week, BFR can be used as their strength work when the athlete has a
short turn around between games but needs to continue building
strength. Then when they have a gap in their schedule, they can do a
traditional high intensity workout.
NBA Super Star Dwight Howard was recently featured on ESPN for using
BFR as part of his training program in season.

Endurance Athlete

Implement twice weekly blood flow restriction training for maintenance

of strength as your endurance training volume increases and reap the
potential VO2max benefits. Cycle at 40% of your VO2max for 15 minutes.

https://www.instagram.com/p/BDD64XCBE7S/?taken-by=...

Deload Weeks

Need a break from the heavy lifts? BFR on deload weeks is the perfect
way to keep strength and hypertrophy going while allowing your body to
recover.

Weak Body Parts

While research on traditional resistance exercise suggests 12 weeks of

work must be put in before seeing significant improvements, studies on
BFR have show significant hypertrophy gains in 2 weeks!

Thus, it’s a great tool to rapidly bring up weak body parts.

Recovery & Prehab

As we previously discussed, blood flow restriction training results in a

huge release of growth hormone, a key hormone for protecting tendons
and muscle structure. BFR can thus be used as a recovery tool or
prehab tool. I have some athletes prone to injuries in certain areas
regularly perform BFR as a way to augment their body’s regeneration to
avoid recurring injuries. blood flow restriction strength

Rehab

Finally, BFR has huge implications for rehab. Injuried individuals often
cannot load a muscle or joint with maximal loads need to builid strength
and hypertrophy. BFR solves this problem and because of those great
growth hormone responses, we’ve seen rapid changes in many injuries
such as tennis elbow, patellar tendonitis, and muscle strains.

From a post-surgical perspective. During periods of non-weight bearing,

BFR has been shown to be highly effective at minimizing the loss of
strength and muscle mass. When post-surgical patients can’t perform
heavy loaded exercises, BFR solves the strength problem…without
using any exercises outside the surgeon’s protocol. Now those low level
“strength” moves you are limited to during early rehab can actually
create strength and hypertrophy gains.

NOTE: Tourniquets are FDA regulated medical devices. If using blood

flow restriction in the rehab setting please use an FDA approved
device such as the one offered at OwensRecoveryScience.com. blood
flow restriction strength

A great example can be seen in the following video. Jared Fleming, and
elite Olympic lifters who holds the American record in the snatch, used
blood flow restriction training as part of his ACL reconstruction rehab.
While many studies show quad weakness and atrophy long after ACL
reconstructions, Jared’s surgical leg was 1 inch larger than his non-
surgical only three months out!

https://www.instagram.com/p/BDEIslxBE20/?taken-by=...

For clinicians wanting to know more about blood flow restriction

training, check out courses offered at OwensRecoveryScience.com.
The Best Blood Flow Restriction
Bands and Devices

The Best Blood Flow Restriction Bands

I am frequently asked about the best devices for performing blood flow
restriction training. As with any trend in the fitness world, many
manufacturers have come out with products recently. And like most
fitness tools, the best device is highly related to your goals.
Unfortunately, some devices on the market have the potential to
cause more harm than good, so choosing the appropriate device is
needed for both your health and for consistency of performance.

In this, the first of three articles coming out on blood flow restriction
training we will cover the first step in BFR...choosing the right device.
Choosing the right device based on your goals and safety needs is the
first and most important step in implementing BFR into your training or
rehab program.

COMPRESSION BAND

First up, and most commonly used are various compression bands to
occlude blood flow. These bands have one really great advantage in
that they are very cheap (or even free if you have some lying around).
The athlete wraps his or her extremity with a compression band at 4-
5/10 intensity for the upper arm or 6-7/10 intensity for the legs is most
commonly prescribed.

The major drawback of these compression bands is that they cannot be

reliable performed in multiple workouts at the exact same level of
occlusion. It makes standardizing the level of pressure very difficult.
Thus, one workout may be super intense at the prescribed weight and
reps while the next may be unbelievably easy.

BLOOD FLOW RESTRICTION BANDS

Up next, you’ll find various commercially sold blood flow restriction

bands. Again, these are a cheap option but have two bid drawbacks.
The level of occlusion with these again cannot be reliably reproduced.
More importantly, many of these bands are very thin. Thus, the pressure
of the band is put through a much smaller area, risking injury to the
underlying nerves. In fact, on several occasions, these bands have
create nerve paralysis. So, if you are buying one of these bands, please
choose one that is thick, preferably covering about ¼ to 1/3 of the
extremity.

Occlusion Cuff

The Occlusion Cuff has been recently released and does a great job of
addressing the above problems. It is essentially a specialized blood
pressure cuff designed for blood flow restriction training. At $125 it’s a
great deal given that it is wide enough to not put unnecessary pressure
on the underlying nerves and the sphygmamometer on the Occlusion
Cuff allows the individual to precisely measure the level of occlusion.
This means workouts will be more standardized to the individual and
the exact same amount of pressure can be applied at different
workouts. The Occlusion Cuff also comes in a two-pack, allowing you to
train both right and left sides at the same time.

For a detailed program on the science and use of BFR check out Dr.
Mario Novo's Blood Flow Restriction Training Manual, available in our
store.

DELPHI PERSONAL TOURNIQUET SYSTEM

The gold standard blood flow restriction training device is the Delphi
Personal Tourniquet System from OwensRecoveryScience.com. This
device contains a Doppler ultrasound within the blood flow restriction
cuff. This means we have the most accurate way possible to measure
blood flow in the extremity and can precisely occlude the appropriate
amount of flow. Safety features within the device include rapid shut offs,
automatic times, and the Doppler are amazing features.

Most importantly for those in the medical community, the Delphi Blood
Flow Restriction device is the only FDA-approved device for BFR. The
FDA defines full or partial vascular occlusion under "tourniquets" and is
regulated that way. Thus, if a patient were to have a negative side effect
during BFR training while using a Delphi unit, you can feel legally safe.
Using other devices opens you up to litigation because a non-FDA
approved device is being used to restrict blood flow.

So, What's The Best?

There are two winners:

First, the Occlusion Cuff is the clear good for athletes, strength
coaches, and personal trainers. Its ability to measure pressure to
accurately reproduce pressure between workouts is great. At a price
tag of $125, it meets most people's budgets as well.

For the rehab professional, the Delphi unit wins. This machine is
fantastic, with doppler ultrasound and safety features built in. The FDA-
approval also makes it a much better option from a legal standpoint. It
is the gold standard in BFR due to its safety features, accuracy, and
performance.

made with